STEMI mimics

Question 1

STEMI Mimics list

Answer 1

Hypothermia
Raised ICP
LBBB
Paced rhythms
Bragada syndrome
Electrolyte disturbance
PE
LVH
Benign early repolarisation
Pericarditis

Question 2

Benign early repolarisation pathophysiology

Answer 2

Pathophysiology is largely misunderstood. Thought to be related to increased epicardium ion channel flow compared to endocardium causing variable myocardial excitability.

Question 3

BER age considerations

Answer 3

Common in people under 50.
In people over 50, suspect STEMI and not BER.

Question 4

BER ECG feature

Answer 4

widespread concave ST segment elevation in precordial leads
Slurred/notched J points
Prominent, slightly asymmetrical T waves concordant with QRS.
ST/T ratio <0.25

Question 5

Pericarditis pathophysiology

Answer 5

pericardium becomes acutely inflamed and undergoes infiltration of leukocytes and pericardial vascularisation due to infectious or non infectious causes.

Question 6

Pericarditis signs and symptoms

Answer 6

Sharp, stabbing chest pain which worsens on lying down and dep breathing.
Causes palpitations SOB, coughing, fever, weakness, fatigue and peripheral oedema.

Question 6

pericardium pathology

Answer 6

ligamental function to fix the heart in place.
protective function preventing infection and malignancy
mechanical function limiting cardiac dilation and improving ventricular compliance.

Question 7

Pericarditis ECG changes

Answer 7

widespread concave ST segment elevation and PR depression in limb leads and precordial leads
Reciprocal ST depression and PR elevation in aVR and V1
Sinus tachycardia due to pain or pericardial effusion.
Spodicks sign = downward sloping TP segment
ST/T wave ratio >0.25